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Serial extractions in orthodontics

Serial extractions in orthodontics

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Serial extractions are a preventive and interceptive procedure that consists of strategically extracting certain temporary teeth in situations where there is a severe lack of space in the mouth and/or the eruption path of the permanent teeth is abnormal. Like a compass, this procedure aims at orienting the teeth to facilitate their eruption.

 

Radiograph showing a different eruption pattern for both permanent upper canines that are still in the gingiva. (A) On the right side, the canine has an eruption path parallel to that of the lateral incisor which remains straight (yellow arrows). (C) On the opposite side, the canine collides with the lateral incisor that tilts backward and tips forward (blue arrows). The serial extraction of temporary teeth can help influence the eruption path and guide the left canine for this 9.9-year-old boy.

 

Eruption problems visible on a radiograph.

The panoramic radiograph of this 10-year-old girl allows the detection of several eruption problems (circled) for which an intervention is indicated. The extraction of temporary teeth can help change the abnormal eruption path of permanent teeth.

The permanent canines often need help! Serial extractions make it possible to influence the eruption path of the permanent teeth and particularly the permanent upper canines which are often tilted forward. The example on the opposite side shows how the extraction of two temporary teeth allowed one canine (red dotted line) to upright and head toward where it must erupt in the arch. Even if this intervention helps the eruption of the canine, there is still a lot of space missing to allow this tooth to erupt normally and orthodontic corrections will still be necessary later on to correct this situation and obtain a normal occlusion. To know more on impacted and ectopic canines.

Serial extraction and eruption guidance to help the eruption of a canine.

(A) Canine tilted toward the lateral incisor (dotted line). The temporary teeth indicated by a (*) will be extracted. (B) A little more than one year after the extractions, there is a significant improvement of the eruption path of the permanent canine.

When there is a severe lack of space for the eruption of the permanent teeth, temporary teeth can be extracted (X) to help the permanent teeth erupt (arrows).

When there is a severe lack of space for the eruption of the permanent teeth, temporary teeth can be extracted (X) to help the permanent teeth erupt (arrows).

 

Significant crowding in both arches in a 9-year-old young girl. Serial extractions of the temporary canines (indicated by asterisks *) will relieve the anterior crowding and help the eruption problems affecting the other permanent teeth.

Why don’t temporary teeth fall out by themselves?

People frequently ask us this question when we recommend serial extractions.

The reason to extract temporary teeth during an interceptive phase in orthodontics is not that these teeth do “not want to fall out” by themselves, but rather we want to extract them before they exfoliate (shed) by themselves because it could still take several months to more than one year before this would happen naturally and during that time, the eruption problems persist and can often worsen.

What would happen if the selected teeth were not extracted?

Teeth to extract serially or early would all end up shedding by themselves eventually. The problem is that it would occur too late to modify the eruption path of permanent teeth that will replace them and which already show an abnormal and potentially problematic eruption path. The additional delay may cause several eruption problems and worsen the developing malocclusion.

Space that is worth gold!Serial extraction dental space

Robbing Peter to pay Paul!
This metaphor clearly illustrates what we try to do with serial extractions, that is stealing some space from someone (temporary teeth) to give back to someone else (permanent teeth).

To find out more on jaw growth and development.

 

Will I avoid an orthodontic treatment with these extractions?

NO, absolutely not!

Although this procedure does not guarantee that permanent teeth will come out adequately, most of the time, it still contributes to minimizing eruption problems and will often facilitate orthodontic corrections that will be indicated when the permanent teeth have erupted.

Dental radiographs: an essential diagnostic help

To know how the evaluation of the position of canines on panoramic radiographs at an early age can allow us to intervene early and maximize the chances that these teeth erupt the best way possible, follow this link.

Prediction of eruption of potentially impacted canines

Prediction methods for canine impaction developed by Ericson and Kurol by evaluating (A) the position of the canine compared to zones defined on a panoramic radiograph, and (B) the distance of the tip of the canine compared to an (occlusal) plane. (C) Success rate of canine autoeruption if the temporary canine is extracted depending on its position compared to a bisector traced on the lateral incisor.

Pathology (cyst) around upper impacted canines

 

A real case!

Example of the importance of taking dental radiographs

Radiographs make it possible to locate and identify the presence of impacted teeth as shown in this example. (A) This young patient complained about a “bump in the palate” (indicated by the arrows). (B, C) In the mouth, the permanent upper left canine is missing (arrow) although the parents believed that it was extracted! (D) The X-ray confirms the presence of an impacted canine.

 

➡ To know more on dental radiographs.

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